House Study Bill 176 - Introduced SENATE/HOUSE FILE _____ BY (PROPOSED DEPARTMENT OF HEALTH AND HUMAN SERVICES BILL) A BILL FOR An Act relating to mental health and disability services 1 provided by the state and judicial procedures relating to 2 child in need of assistance proceedings, adoptions, and the 3 confinement of persons found incompetent to stand trial. 4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 5 TLSB 1183XD (13) 90 dg/rh

S.F. _____ H.F. _____ DIVISION I 1 STATE MENTAL HEALTH INSTITUTES —— SPECIALIZATION 2 Section 1. Section 226.1, subsection 2, paragraph a, 3 subparagraph (1), Code 2023, is amended to read as follows: 4 (1) Treatment, training, care, habilitation, and support 5 of persons with mental illness or a substance abuse problem 6 including: 7 (a) Specialized treatment of behaviorally complex youth at 8 a mental health institute located in Independence. 9 (b) Specialized treatment and security for adults ordered 10 by the court into the custody of the state for the purposes of 11 competency restoration, adults who have been acquitted of a 12 crime by reason of insanity, and similarly situated adults at a 13 mental health institute in Cherokee . 14 DIVISION II 15 CHILD IN NEED OF ASSISTANCE —— SAFETY PLANS —— TEMPORARY 16 REMOVAL 17 Sec. 2. Section 232.79B, subsections 1, 2, and 3, Code 2023, 18 are amended to read as follows: 19 1. For the purposes of this section , “safety plan” means 20 a short-term, time-limited agreement entered into between the 21 department and a child’s parent or guardian designed to address 22 signs of imminent or impending danger to a child identified by 23 the department. 24 2. Upon the department’s determination that potential harm 25 to a child may be mitigated by the development of a safety 26 plan, the department may enter into a safety plan with the 27 child’s parent or guardian . 28 3. A safety plan shall not be construed as a removal from 29 parental or guardian custody absent a court order placing 30 the child with a person or facility other than the parent or 31 guardian who entered into the safety plan. 32 Sec. 3. Section 232.95, subsection 4, Code 2023, is amended 33 to read as follows: 34 4. If the court orders the child removed from the home 35 -1- LSB 1183XD (13) 90 dg/rh 1/ 14

S.F. _____ H.F. _____ pursuant to subsection 2 , paragraph “a” “b” or “c” , the court 1 shall hold a hearing to review the removal order within six 2 months unless a dispositional hearing pursuant to section 3 232.99 has been held. 4 Sec. 4. Section 232.102, subsection 10, Code 2023, is 5 amended by striking the subsection. 6 DIVISION III 7 MENTAL HEALTH AND DISABILITY SERVICES REGIONS —— GOVERNANCE —— 8 CASH RESERVES —— CORE SERVICES —— REPORT 9 Sec. 5. Section 225C.7A, subsection 7, Code 2023, is amended 10 by striking the subsection and inserting in lieu thereof the 11 following: 12 7. For the fiscal year beginning July 1, 2023, and each 13 succeeding fiscal year, each mental health and disability 14 services region for which the amount certified during the 15 fiscal year under section 331.391, subsection 4 , paragraph “b” , 16 exceeds ten percent of the actual expenditures of the region 17 for the fiscal year preceding the fiscal year in progress, the 18 remaining quarterly payments of the region’s regional service 19 payment shall be reduced by an amount equal to the amount by 20 which the region’s amount certified under section 331.391, 21 subsection 4 , paragraph “b” , exceeds ten percent of the actual 22 expenditures of the region for the fiscal year preceding the 23 fiscal year in progress, but the amount of the reduction 24 shall not exceed the total amount of the region’s regional 25 service payment for the fiscal year. If the region’s remaining 26 quarterly payments are insufficient to effectuate the required 27 reductions under this paragraph, the region is required to 28 pay to the department any amount for which the reduction in 29 quarterly payments could not be made. The amount of reductions 30 to quarterly payments and amounts paid to the department under 31 this paragraph shall be transferred and credited to the region 32 incentive fund under subsection 8 . 33 Sec. 6. Section 225C.7A, subsection 8, paragraph c, 34 subparagraph (2), subparagraph division (b), Code 2023, is 35 -2- LSB 1183XD (13) 90 dg/rh 2/ 14

S.F. _____ H.F. _____ amended by striking the subparagraph division and inserting in 1 lieu thereof the following: 2 (b) For applications for fiscal years beginning on or after 3 July 1, 2023, ten percent of the actual expenditures of the 4 mental health and disability services region for the fiscal 5 year that commenced two years prior to the fiscal year of 6 application for assistance. 7 Sec. 7. Section 331.390, subsection 2, Code 2023, is amended 8 by striking the subsection and inserting in lieu thereof the 9 following: 10 2. The governing board shall comply with all of the 11 following requirements: 12 a. Each member of the governing board shall have one vote. 13 b. The membership of the governing board shall not include 14 employees of the department of health and human services or a 15 nonelected employee of a county. 16 c. The membership of the governing board shall consist of 17 the following: 18 (1) Members representing the boards of supervisors of 19 counties comprising the region. Members representing the 20 boards of supervisors for a region’s counties shall not exceed 21 forty-nine percent of the total membership of the governing 22 board. 23 (2) One member who is an adult person who utilizes mental 24 health and disability services or is an actively involved 25 relative of such an adult person. This member shall be 26 designated by the regional advisory committee formed by the 27 governing board pursuant to paragraph “d” . 28 (3) One member representing adult service providers in 29 the region. This member shall be designated by the regional 30 advisory committee formed by the governing board pursuant to 31 paragraph “d” . 32 (4) One member representing children’s behavioral health 33 services providers in the region. This member shall be 34 designated by the regional children’s advisory committee formed 35 -3- LSB 1183XD (13) 90 dg/rh 3/ 14

S.F. _____ H.F. _____ by the governing board pursuant to paragraph “e” . 1 (5) One member representing the education system in the 2 region. This member shall be designated by the regional 3 children’s advisory committee formed by the governing board 4 pursuant to paragraph “e” . 5 (6) One member who is a parent of a child who utilizes 6 children’s behavioral health services or who is an actively 7 involved relative of such a child. This member shall be 8 designated by the regional children’s advisory committee formed 9 by the governing board pursuant to paragraph “e” . 10 (7) One member representing law enforcement in the region. 11 (8) One member representing the judicial system in the 12 region. 13 d. The governing board shall have a regional advisory 14 committee consisting of adults who utilize services or actively 15 involved relatives of such adults, service providers, and 16 regional governing board members. 17 e. The governing board shall have a regional children’s 18 advisory committee consisting of parents of children who 19 utilize services or actively involved relatives of such 20 children, a member of the education system, an early childhood 21 advocate, a child welfare advocate, a children’s behavioral 22 health service provider, a member of the juvenile court, a 23 pediatrician, a child care provider, a local law enforcement 24 representative, and regional governing board members. 25 Sec. 8. Section 331.391, subsection 4, paragraph c, Code 26 2023, is amended to read as follows: 27 c. For fiscal years beginning on or after July 1, 2023, the 28 region’s cash flow amount shall not exceed five ten percent 29 of the actual expenditures from the combined account for the 30 fiscal year preceding the fiscal year in progress. 31 Sec. 9. Section 331.397, subsection 4, Code 2023, is amended 32 by adding the following new paragraph: 33 NEW PARAGRAPH . g. Outpatient competency restoration. 34 Sec. 10. Section 331.397A, subsection 4, Code 2023, is 35 -4- LSB 1183XD (13) 90 dg/rh 4/ 14

S.F. _____ H.F. _____ amended by adding the following new paragraph: 1 NEW PARAGRAPH . c. Outpatient competency restoration. 2 Sec. 11. Section 331.400, Code 2023, is amended to read as 3 follows: 4 331.400 Quarterly Annual reports. 5 Beginning with the fiscal year beginning July 1, 2022 2023 , 6 the department shall deliver on a quarterly an annual basis 7 a report to the general assembly that provides a summary of 8 the status of implementing core services in each region, 9 the accessibility of core services in each region, how each 10 region is using the funding provided under section 225C.7A , 11 and recommendations for improvements to the mental health and 12 disability services system in order to attain the outcome 13 improvement goals set by the department consistent with the 14 goals specified in the performance-based contracts under 15 section 225C.7A, subsection 2 , paragraph “c” , subparagraph (5). 16 DIVISION IV 17 ADOPTION NOTICES —— HEARINGS 18 Sec. 12. Section 600.11, subsection 2, paragraph a, 19 subparagraph (7), Code 2023, is amended by striking the 20 subparagraph. 21 Sec. 13. Section 600.11, subsection 2, Code 2023, is amended 22 by adding the following new paragraph: 23 NEW PARAGRAPH . 0b. (1) At least twenty days prior to the 24 adoption hearing, a copy of the order setting the adoption 25 hearing shall be provided to siblings of the person to be 26 adopted when either of the following applies: 27 (a) The sibling and the person to be adopted have an 28 existing relationship. 29 (b) There is a court finding that ongoing contact with 30 the person to be adopted is in the best interest of each 31 sibling and the person to be adopted was a minor child when the 32 parents of the person to be adopted had their parental rights 33 terminated subsequent to the person to be adopted having been 34 adjudicated a child in need of assistance. 35 -5- LSB 1183XD (13) 90 dg/rh 5/ 14

S.F. _____ H.F. _____ (2) Notwithstanding subsection 3, a copy of the order 1 setting the adoption hearing may be provided to a sibling via 2 ordinary mail if the sibling’s address is known. A copy of an 3 order setting an adoption hearing sent to a sibling under ten 4 years of age shall be addressed to the sibling’s custodian or 5 guardian. 6 (3) This paragraph does not require a copy of the order 7 setting the adoption hearing to be provided to any of the 8 following: 9 (a) A person whose parental rights have been terminated with 10 regard to the person to be adopted. 11 (b) Siblings who are placed with the sibling to be adopted 12 at the time the court issued the order setting the adoption 13 hearing. 14 (c) A previously adopted sibling, unless the siblings were 15 the subjects of child in need of assistance or termination of 16 parental rights proceedings that occurred at the same time. 17 DIVISION V 18 CONFINEMENT OF PERSONS FOUND INCOMPETENT TO STAND TRIAL 19 Sec. 14. Section 812.6, subsection 1, Code 2023, is amended 20 to read as follows: 21 1. If the court finds the defendant does not pose a danger 22 to the public peace and safety, is otherwise qualified for 23 pretrial release, and is willing to cooperate with treatment, 24 the court shall order, as a condition of pretrial release, 25 that the defendant obtain mental health treatment designed to 26 restore the defendant to competency. The costs of treatment 27 pursuant to this subsection shall be paid by the mental 28 health and disability services region for the county of the 29 defendant’s residency pursuant to chapter 225C regardless of 30 whether the defendant meets financial eligibility requirements 31 under section 225C.62 or 225C.66. 32 Sec. 15. Section 812.7, Code 2023, is amended to read as 33 follows: 34 812.7 Mental status reports. 35 -6- LSB 1183XD (13) 90 dg/rh 6/ 14

S.F. _____ H.F. _____ The psychiatrist or licensed doctorate-level psychologist 1 providing evaluating the progress of the outpatient competency 2 restoration treatment to of the defendant, or the director of 3 the facility where the defendant is being held and treated 4 pursuant to a court order, shall provide a written status 5 report to the court regarding the defendant’s mental disorder 6 within , methods used to restore competency to the defendant, 7 the defendant’s current abilities related to competency, 8 and whether it appears the defendant’s competency can be 9 restored within a reasonable amount of time. The psychiatrist, 10 psychologist, or director shall submit an initial report to 11 the court no later than thirty days of after the defendant’s 12 placement pursuant to section 812.6 . The report shall also 13 state whether it appears that the defendant can be restored to 14 competency in a reasonable amount of time. Progress reports 15 shall be provided to the court , and subsequent reports every 16 sixty days or less thereafter after the submission of the 17 initial report until the defendant’s competency is restored or 18 the placement of the defendant is terminated. 19 Sec. 16. Section 812.8, subsections 1 and 3, Code 2023, are 20 amended to read as follows: 21 1. At any time, upon a finding by a psychiatrist or licensed 22 doctorate-level psychologist that there is a substantial 23 probability that the defendant has acquired the ability 24 to appreciate the charge, understand the proceedings, and 25 effectively assist in the defendant’s defense, the psychiatrist 26 or licensed doctorate-level psychologist providing evaluating 27 the progress of the defendant’s outpatient treatment to the 28 defendant or the director of the inpatient facility shall 29 immediately notify the court. After receiving notice the court 30 shall proceed as provided in subsection 4 . 31 3. At any time upon a finding by a treating an evaluating 32 psychiatrist or licensed doctorate-level psychologist that 33 there is no substantial probability that the defendant will 34 be restored to competency in a reasonable amount of time, 35 -7- LSB 1183XD (13) 90 dg/rh 7/ 14

S.F. _____ H.F. _____ the psychiatrist or licensed doctorate-level psychologist 1 providing evaluating the defendant’s outpatient treatment to 2 the defendant or the director of the inpatient facility shall 3 immediately notify the court. Upon receiving notification, the 4 court shall proceed as provided under subsection 4 . 5 DIVISION VI 6 CONFORMING CODE CHANGES 7 Sec. 17. Section 256.25, subsections 2 and 3, Code 2023, are 8 amended to read as follows: 9 2. A school district, which may collaborate and partner 10 with one or more school districts, area education agencies, 11 accredited nonpublic schools, nonprofit agencies, and 12 institutions that provide children’s mental health services, 13 located in mental health and disability services regions 14 providing children’s behavioral health services in accordance 15 with chapter 331 225C , subchapter III VII , part 6, may apply 16 for a grant under this program to establish a therapeutic 17 classroom in the school district in accordance with this 18 section . 19 3. The department shall develop a grant application 20 and selection and evaluation criteria. Selection criteria 21 shall include a method for prioritizing grant applications 22 submitted by school districts. First priority shall be given 23 to applications submitted by school districts that submitted an 24 application pursuant to this section for the previous fiscal 25 year. Second priority shall be given to applications submitted 26 by school districts that, pursuant to subsection 2 , are 27 collaborating and partnering with one or more school districts, 28 area education agencies, accredited nonpublic schools, 29 nonprofit agencies, or institutions that provide mental health 30 services for children. Third priority shall be given to 31 applications submitted by school districts located in mental 32 health and disability services regions providing behavioral 33 health services for children in accordance with chapter 331 34 225C , subchapter III, part 6 VII . Grant awards shall be 35 -8- LSB 1183XD (13) 90 dg/rh 8/ 14

S.F. _____ H.F. _____ distributed as equitably as possible among small, medium, and 1 large school districts. For purposes of this subsection , a 2 small school district is a district with an actual enrollment 3 of fewer than six hundred pupils; a medium school district is a 4 district with an actual enrollment that is at least six hundred 5 pupils, but less than two thousand five hundred pupils; and a 6 large school district is a district with an actual enrollment 7 of two thousand five hundred or more pupils. 8 DIVISION VII 9 CODE EDITOR DIRECTIVE —— MENTAL HEALTH AND DISABILITY SERVICES 10 CODE TRANSFERS 11 Sec. 18. CODE EDITOR DIRECTIVE. 12 1. The Code editor is directed to make the following 13 transfers: 14 a. Section 331.388 to section 225C.55. 15 b. Section 331.389 to section 225C.56. 16 c. Section 331.390, as amended in this Act, to section 17 225C.57. 18 d. Section 331.391, as amended in this Act, to section 19 225C.58. 20 e. Section 331.392 to section 225C.59. 21 f. Section 331.393 to section 225C.60. 22 g. Section 331.394 to section 225C.61. 23 h. Section 331.395 to section 225C.62. 24 i. Section 331.396 to section 225C.63. 25 j. Section 331.396A to section 225C.64. 26 k. Section 331.397, as amended in this Act, to section 27 225C.65. 28 l. Section 331.397A, as amended in this Act, to section 29 225C.66. 30 m. Section 331.398 to section 225C.67. 31 n. Section 331.399 to section 225C.68. 32 o. Section 331.400, as amended in this Act, to section 33 225C.69. 34 2. The Code editor shall correct internal references in the 35 -9- LSB 1183XD (13) 90 dg/rh 9/ 14

S.F. _____ H.F. _____ Code and in any enacted legislation as necessary due to the 1 enactment of this section. 2 3. The Code editor may add a new subchapter to chapter 3 225C preceding section 225C.55 entitled “MENTAL HEALTH AND 4 DISABILITY SERVICES —— REGIONAL SERVICE SYSTEM —— CHILDREN’S 5 BEHAVIORAL HEALTH SYSTEM”. 6 EXPLANATION 7 The inclusion of this explanation does not constitute agreement with 8 the explanation’s substance by the members of the general assembly. 9 This bill relates to mental health and disability services 10 provided by the state and judicial procedures relating to 11 child in need of assistance proceedings, adoptions, and the 12 confinement of persons found incompetent to stand trial. The 13 bill is organized into divisions. 14 DIVISION I —— STATE MENTAL HEALTH INSTITUTES —— 15 SPECIALIZATION. The bill removes persons who solely have a 16 substance abuse problem as a population eligible to receive 17 treatment, training, care, habilitation, and support at a state 18 mental health institute. 19 The bill designates the state mental health institute 20 located in Independence, Iowa, for specialized treatment of 21 behaviorally complex youth, and designates the state mental 22 health institute located in Cherokee, Iowa, for specialized 23 treatment and security of adults ordered by the court into 24 the custody of the state for the purposes of competency 25 restoration, adults who have been acquitted of a crime by 26 reason of insanity, and similarly situated adults. 27 DIVISION II —— CHILD IN NEED OF ASSISTANCE —— SAFETY PLANS 28 —— TEMPORARY REMOVAL. The bill allows, in a child in need 29 of assistance proceeding, a child’s guardian to enter into a 30 safety plan, and prohibits a safety plan from being construed 31 as a child’s removal from a guardian absent a court order 32 placing the child with a person or facility other than the 33 guardian who entered into the safety plan. 34 The bill makes a corrective change to Code section 35 -10- LSB 1183XD (13) 90 dg/rh 10/ 14

S.F. _____ H.F. _____ 232.95(2)(a) relating to hearings concerning the temporary 1 removal of a child in child in need of assistance cases. 2 The bill strikes Code section 232.102(10) relating to 3 transfer of legal custody of a child in a child in need of 4 assistance case for placement and visitation of the child by 5 the child’s grandparents, great-grandparents, and certain other 6 adult relatives. 7 DIVISION III —— MENTAL HEALTH AND DISABILITY SERVICES 8 REGIONS —— GOVERNANCE —— CASH RESERVES —— CORE SERVICES —— 9 REPORT. The bill increases the amount of moneys a mental 10 health and disability services (MHDS) regional combined account 11 may have before payments to the MHDS region are reduced and 12 an MHDS region is disqualified from receiving funding from 13 an MHDS incentive fund. The bill provides that, for fiscal 14 years beginning on or after July 1, 2023, an MHDS region’s cash 15 reserves cannot exceed 10 percent of the actual expenditures 16 from the combined account for the fiscal year preceding the 17 fiscal year in progress. Under current law, for fiscal years 18 beginning on or after July 1, 2023, an MHDS region’s cash 19 reserves cannot exceed 5 percent of the actual expenditures 20 from the combined account for the fiscal year preceding the 21 fiscal year in progress. 22 The bill makes changes to the regional governance of 23 MHDS governing boards. The bill allows each member of an 24 MHDS governing board to have a vote, limits the number of 25 representatives county boards of supervisors may have on an 26 MHDS regional governing board to 49 percent of the total 27 governing board membership, and adds a member representing law 28 enforcement and a member representing the judicial system in an 29 MHDS region as representatives on an MHDS governing board. 30 The bill limits an MHDS region’s cash flow amount to 10 31 percent of the actual expenditures from the combined account 32 for the fiscal year preceding the fiscal year in progress. 33 Under current law, the cash flow amount is limited to 5 percent 34 of the actual expenditures from the combined account for the 35 -11- LSB 1183XD (13) 90 dg/rh 11/ 14

S.F. _____ H.F. _____ fiscal year preceding the fiscal year in progress. 1 The bill adds outpatient competency restoration as a core 2 service for both adult and children’s MHDS regions. 3 The bill requires the department of health and human 4 services (HHS) to deliver a report on an annual basis to the 5 general assembly that provides a summary of the status of 6 implementing core services in each region, the accessibility 7 of core services in each region, how each region is using the 8 funding provided to MHDS regions, and recommendations for 9 improvements to the MHDS system in order to attain the outcome 10 improvement goals set by HHS. Under current law, HHS is 11 required to give such a report on a quarterly basis. 12 DIVISION IV —— ADOPTION NOTICES —— HEARINGS. The bill 13 requires an adoption petitioner to provide a copy of the order 14 setting the adoption hearing to siblings of a person to be 15 adopted at least 20 days prior to the adoption hearing when 16 there is either an existing relationship or a court finding 17 that ongoing contact with the person to be adopted is in the 18 best interests of each sibling and the person to be adopted was 19 a minor child when the parents of the person to be adopted had 20 their parental rights terminated subsequent to the person to be 21 adopted having been adjudicated a child in need of assistance. 22 The bill allows a copy of the order setting the adoption 23 hearing to be provided to a sibling via ordinary mail if the 24 sibling’s address is known. A copy of an order setting an 25 adoption hearing sent to a sibling under 10 years of age shall 26 be addressed to the sibling’s custodian or guardian. 27 The bill does not require a copy of the order setting the 28 adoption hearing to be provided to a person whose parental 29 rights have been terminated with regard to the person to be 30 adopted; siblings who are placed with the sibling to be adopted 31 at the time the court issued the order setting the adoption 32 hearing; or a previously adopted sibling, unless the siblings 33 were the subjects of child in need of assistance or termination 34 of parental rights proceedings that occurred at the same time. 35 -12- LSB 1183XD (13) 90 dg/rh 12/ 14

S.F. _____ H.F. _____ DIVISION V —— CONFINEMENT OF PERSONS FOUND INCOMPETENT TO 1 STAND TRIAL. The bill requires the MHDS region for the county 2 of a defendant’s residency to pay for the costs of mental 3 health treatment the defendant receives as a condition of 4 pretrial release. 5 The bill allows a psychiatrist or licensed doctorate-level 6 psychologist evaluating the progress of a defendant’s 7 outpatient competency restoration treatment, or the director 8 of the facility where the defendant is being held and treated 9 pursuant to a court order, to provide a written status report 10 to the court regarding the defendant’s mental disorder. Under 11 current law, only the psychiatrist or licensed doctorate 12 level psychologist providing the defendant’s treatment or the 13 director of the facility where the defendant is being held and 14 treated can provide the written status report. 15 The bill requires a written status report prepared for an 16 incompetent defendant to include the methods used to restore 17 competency to the defendant, the defendant’s current abilities 18 related to competency, and whether it appears the defendant’s 19 competency can be restored within a reasonable amount of time. 20 The bill requires a psychiatrist, psychologist, or director to 21 submit an initial report to the court no later than 30 days 22 after the defendant’s placement by the court for treatment, and 23 subsequent reports every 60 days or less after submission of 24 the initial report until the defendant’s competency is restored 25 or the placement of the defendant is terminated. 26 The bill requires a psychiatrist or licensed doctorate-level 27 psychologist evaluating the progress of a defendant’s 28 outpatient competency restoration treatment, or the director 29 of the facility where the defendant is being held and treated 30 pursuant to a court order, to notify a court if there is a 31 substantial probability or is no substantial probability that 32 a defendant formerly deemed incompetent either has acquired 33 the ability to appreciate the charge against the defendant, 34 understand the proceedings, and effectively assist in the 35 -13- LSB 1183XD (13) 90 dg/rh 13/ 14

S.F. _____ H.F. _____ defendant’s defense or will be restored to competency in 1 a reasonable amount of time. Under current law, only the 2 psychiatrist or licensed doctorate-level psychologist providing 3 the defendant’s treatment or the director of the facility where 4 the defendant is being held and treated could provide such 5 notice to a court. 6 DIVISION VI —— CONFORMING CODE CHANGE. The bill makes a 7 conforming change to Code section 256.25 (therapeutic classroom 8 incentive grant program —— fund). 9 DIVISION VII —— CODE TRANSFERS. The bill transfers Code 10 sections 331.388 through 331.400 (mental health and disability 11 services —— regional service system —— children’s behavioral 12 health system) to Code sections 225C.55 through 225C.69 and 13 directs the Code editor to make conforming changes. 14 -14- LSB 1183XD (13) 90 dg/rh 14/ 14